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01 PAR j0�
ECITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
Ni TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 79.75
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*ivEsD
I.white File PERMIT NO. /(—i QJ S
2. Pink City I
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ` ZONING(office use)
5615 Forest Court SE. Prior Lake, MN 55372 /2A,,
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID a--�• Z. W J,0
OWNER
Ye Yang/Duo Duo Wang (Phone) (952)201-9081
(Address)5615 Forest Court SE. Prior Lake, MN 55372
BUILDER Custom Remodelers, Inc. (651)784-2646
(Company Name) (Phone)
(Contact Name) Karli Anderson (Phone) (651)784-2646
(Address) 474 Apollo Drive. Lino Lakes, MN 55014
TYPE OF WORK 0 New Construction ❑Deck ❑PorchBlue-Roofing DRe-Siding ['Lower Level Finish 0 Fireplace
['Addition DAlteration ['Utility Con n
CODE: DI.R.C. ❑I.B.C. ElMisc: RE-ROOF
Type of Construction: I II III IV V AB 13 000.00
Occupancy Group: ABE F A I MR SU PROJECT COST/VALUE $ '
Division: 1 2 3 4 5 (excluding land)
I hereby cc ify that I have famished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above- a Toned pro and that all constmction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official revo te tt s it for'ust cans- F ermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x ( II 1 `^ CR001748 August 27th 2014
Si a e Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ /`1 C SAC # $
Plan Check Fee $ Meter Size 5/8"; 1"; $
State Surcharge $ 5 e ,(� Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $ -'y-,
Gas Fireplace Permit Fee $ TOTAL DUE $ G/�-�-
This Application Becomes Your Building Permit When Approved Paid '1-C(< I Receipt No. 12--(LO C
Date ,6. 2... ,/,....__(` By S r-t.t..,}
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372